PROJECTSUMMARY Non-medicalorsocialfactorssubstantiallyaffectindividuals?healthoutcomes,qualityofhealthcare andmedicalcosts.Servicesaddressingsocialneedsarerarelyintegratedwithroutinemedicalcare.Despite theimpactofnon-medicalfactorsonthemedicalsystem,littleisknownaboutthebestwaystoaddressnon- medicalneedswithinthemedicalsystem.TheAffordableCareActischangingpaymentmodelsforhealthcare providersthatareattemptingtoshiftfrompayingforeachserviceprovided,whichencourageshighvolumeof services,topayingforthequalityandefficiencyofcare,whichencourageshighvalueofcare.Accountable careorganizations(ACOs),thecentralpaymentreformintheAffordableCareAct,creategroupsofphysicians collectivelyresponsibleforcostsandqualityofcareforapopulationofpatients.Currentestimatessuggest thereareover700ACOsintheUnitedStates,includingapproximately400ACOswithMedicarecontractsand 300withcommercialcontracts;?additionally,18statesarepursuingorimplementingACOcontractswithintheir Medicaidprograms.Giventhesignificantimpactofnon-medicalfactorsonhealthoutcomesandmedicalcosts, healthcareprovidersunderACOcontractsmayaddressunderlyingnon-medicalfactorsasawaytocontrol medicalcostsandimprovequality.Previousresearchhashighlightedthebenefitsofintegratedhealthcare servicesdelivery,buttheoperationalandfinancialconsiderationsofintegratedmedical,non-medicaland socialservicesarepoorlyunderstood. TounderstandhowACOsintegratesocialserviceswithintheACOstructure,wewillconductinterviews with20ACOs.WewillexplorehowACOsinitiate,adapt,modifyandsustaintheirapproachestoaddressing non-medicalneedsandintegratingsocialservicesintomedicalcare.Theinterviewswillhelpusexaminethe motivationsorconstraintsthatmayhaveinfluencedACOstoadoptorchangetheirapproaches.Thisproject leveragesourteam?sconsiderableexperiencewithqualitativeresearchwithACOexecutives,aswellasdeep expertiseonACOmodelsandspecificallyhowACOmodelsworkfordisadvantagedpatients. ThisprojectwillprovideimportantinsightintohowACOsachievegreaterintegrationofsocialservices withclinicalproviders.Resultswillbeofinteresttopolicymakers,providersandpayers,andwillhelpthem implementACOprogramsmostefficiently.